A systemic look at professional burnout and well-being within an urban cancer center as a roadmap to recovery.
Authors: Alyson B. Moadel, Katia Papalezova, Gabrielle Milner, Amber Gipson-Fine, Shalom Kalnicki
Journal: Journal of Clinical Oncology (2022)

11017 Background: As the U.S. health care system’s vulnerabilities have been laid bare by an unremitting pandemic, it behooves us to build in resiliency as we look towards recovery. The “burnout epidemic” facing oncology clinicians has been well documented prior to the pandemic. From a systemic perspective, however, data across the cancer service line is scant. In an effort to identify the stress points and strengths of an oncology service line, we present cross-sectional data from 2018 examining burnout, physical and emotional well-being, and self-care needs across all primary cancer center roles within a major urban cancer center in NYC. Methods: An anonymous online survey was completed by 310 of 646 (48%) cancer service providers comprised of physicians, nurses, clinical support staff, managers, and clerical staff. The abbreviated Maslach Burnout Inventory (MBI-9), the Mental Health Inventory (MHI), and the brief COPE were included. Results: Respondents ranged from nurses (15%) to clinical support staff (29%), with 79% identifying as female. In a snapshot view, 25% of the sample endorsed feeling burned out from work. Rates of emotional exhaustion were highest among nurses (41%) and lowest among physicians (14%), p &lt; 0.06. Depersonalization rates ranged from 1% for physicians to 11% for nurses and clerical staff (p &lt; 0.003). A breakdown of those who would not choose the same career over again: clerical (36%), management (28%), nurses/clinical support staff (23%) and physicians (11%), p &lt; 0.053). Clinical levels of distress ranged from 20% (clerical staff) to 30% (nurses). Self-reported health (1-5) was lower among clerical staff and nurses (3.1) compared to physicians (3.9), p &lt; 0.001. The majority of staff utilized adaptive coping strategies including positive reframing and planning, with religion and humor often endorsed. Interest in counseling and communication skills training ranged from 56%/57% among physicians to 84%/88% among clerical staff, respectively. Conclusions: This panoramic view of one cancer service line just prior to the pandemic points to particular systemic stresses in areas of emotional exhaustion, career choice questioning, and psychological and physical health. While levels of burnout fall within and below rates reported in the literature, it also points to fault lines affecting key service line positions, particularly nurses and clerical staff. At the same time, it highlights an underlying resiliency in coping and receptivity to self-care and development. In response to this internal needs assessment, our cancer center is working towards building a stronger foundation in which staff will not only survive the expected and unexpected stresses of working in health care but find meaning and joy in work. While we cannot predict the future, we can learn from the past. In this vein, a Well-Being Committee that includes representatives across the cancer service line was launched in 2022.